RU2736046C1 - Method of treating chronic pharyngitis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to chronic pharyngitis treatment. That is ensured by washing and rinsing nasal and pharyngeal tissues with 0.1% hydrogen peroxide daily, before using drugs, solution of which is prepared immediately before administering by mixing in one flask of equal volumes 0.5 ml of 1.67% solution of emoxipine succinate, 0.5 ml of 0.33% ampoule solution of novocaine and 0.5 ml of 0.25% ampoule solution of lazolvan - ambroxol hydrochloride, the introduction of the solution is carried out at least twice intranasal drop-by-drop into each nasal passage for 7-8 minutes, vitamin D₃ is prescribed orally daily in a daily dose of 1500-2500 IU for three-four weeks and orally a probiotic complex of Rioflor 1-3 capsules 2 times day for 6 weeks.

EFFECT: achieving stable clinical effect, complete recovery of upper airway mucosal microbiota, prevention of chronic clinical course.

1 cl, 4 tbl, 5 ex

Description

The invention relates to medicine, namely to otorhinolaryngology, and can be used to treat chronic pharyngitis.

A known analogue of the method of treating chronic pharyngitis by using a solution of drugs in the description of the invention to patent No. 2394567, IPC A61K 31/245; A61K 31/4412; A61K 11/04, according to application No. 200910368/14, 17.03.2009, publ. 07/20/2010 in Bul. No. 20, in which novocaine and mexidol (emoxipine succinate) are prescribed as drugs, and the administration of a solution of drugs is carried out intranasally. A solution of drugs is prepared immediately before its administration by mixing in one bottle equal volumes of a 1% ampoule solution of novocaine and a 5% ampoule solution of Mexidol (emoxypine succinate). Intranasal administration of a solution of drugs is carried out daily by drip in a volume of 1 ml for 5 minutes into each nasal passage. Intranasal administration of a solution of drugs is carried out within three to four weeks.

Disadvantages: insufficiently high persistent clinical effect, since it is not possible to completely restore the microbiota of the mucous membrane of the upper respiratory tract, does not prevent the chronic course of the disease.

The closest in technical essence to the claimed invention is a method of treating chronic pharyngitis by using a solution of drugs in the description of the invention to patent No. 2394565, IPC A61K31 / 245; A61K31 / 137; A61K31 / 441; A61K 31/593; A61P 11/04, by application No. 2009110369/14, dated 17.03.2009, publ. 20.07.2010 in bul. No. 20, in which novocaine, lazolvan (ambroxol hydrochloride) and mexidol (emoxypine succinate) are prescribed as drugs for the preparation of the solution, and vitamin D _{3 is} additionally prescribed, the drug solution is prepared immediately before its administration by mixing equal volumes of 1% in one bottle ampoule solution of novocaine, 0.75% ampoule solution of lazolvan (ambroxol hydrochloride) and 5% ampoule solution of mexidol (emoxypine succinate), the introduction of a solution of drugs is carried out intranasally twice daily, twice daily in a volume of 1.5 ml for 7 -8 minutes in each nasal passage, and vitamin D _{3 is} prescribed orally daily in a daily dose of 2000 IU (50 μg), and intranasal administration of a solution of drugs and oral administration of vitamin D _{3 is} carried out for three to four weeks.

Disadvantages: insufficiently high persistent clinical effect, does not completely restore the microbiota of the mucous membrane of the upper respiratory tract, does not prevent the chronic course of the disease. The intestinal microbiocenosis suffers, which does not allow obtaining a stable result of treatment.

EFFECT: achievement of persistence of the clinical effect, complete restoration of the microbiota of the mucous membrane of the upper respiratory tract, prevention of the chronic course of the disease.

The technical result in the method of treating chronic pharyngitis is achieved due to the fact that the nasopharynx and oropharynx are washed and rinsed with hydrogen peroxide, novocaine, lazolvan-ambroxol hydrochloride and mexidol-emoxypine succinate, vitamin D ₃ and the probiotic complex Rioflora are prescribed as medicinal preparations for the preparation of the solution , rinsing and rinsing of the nasopharynx and oropharynx with hydrogen peroxide is carried out daily, with a 0.1% solution, before using drugs, a solution of drugs is prepared immediately before its administration by mixing in one bottle equal volumes of 0.5 ml of 1.67% solution of emoxypine succinate , 0.5 ml of 0.33% ampoule solution of novocaine and 0.5 ml of 0.25% ampoule solution of lazolvan -ambroxol hydrochloride, the introduction of a solution of drugs is carried out at least twice intranasally drip into each nasal passage for 7-8 minutes, vitamin D _{3 is} prescribed orally daily in a daily dose of up to ze 1500 -2500 ME for three to four weeks and oral probiotic complex Rioflora 1-3 capsules 2 times a day for up to 6 weeks.

Hydrogen peroxide, being a water-soluble non-polar compound, is able to quickly diffuse through biological membranes and penetrate into eukaryotic cells and even bacterial biofilms. In the micromolar concentration range, it acts on lysogenic strains of pathogenic bacteria and stimulates the expression of a complex of enzymes for emergency repair of bacterial DNA, thereby sanitizing the mucous membrane from pathogenic microflora.

When vitamin D _{3 is} prescribed, orally daily at a daily dose of 1500-2500 IU, for four to six weeks, epithelial cells upon contact with infectious agents are potentially capable of dramatically increasing the expression of proteins such as cathelicidin and defensin-β-2, which have antimicrobial activity and are active in against many bacteria, viruses and fungi. Cathelicidin, among other things, stimulating angiogenesis and division of epithelial cells, helps to maintain the structural and functional usefulness of the epithelial barrier of the upper respiratory tract. But these protective reactions of epithelial cells can be realized only in the presence of an active form of vitamin D ₃ . The immunomodulatory effect of 1,25-dihydroxyvitamin D ₃ (the active form of vitamin D ₃ ) is mediated by its receptors and is carried out by interacting with the transcription factors NF-AT and NF-kB, or directly with elements of the promoter regions of genes perceiving vitamin D ₃ (expression, at least at least thousands of genes are controlled by vitamin D ₃ ). In the presence of the active form of vitamin D _3, not only the expression of pro-inflammatory cytokines is suppressed, but also the synthesis of microorganism recognition receptors is stimulated. This ensures the colonization resistance of the symbiotic microflora and the timely activation of defense mechanisms upon contact with non-resident microorganisms. The conversion of 25-hydroxyvitamin D ₃ to its active form is catalyzed by 1α-hydroxylase CYP27B1. A sufficient level of this enzyme in epithelial cells is induced only upon contact of microorganisms with the corresponding recognition receptors of the plasma membrane of epithelial cells (symbiotic microorganisms stimulate the maintenance of background 1α-hydroxylase activity in cells of epithelial barriers). Thus, the conditions for achieving a stable clinical effect in the treatment of chronic pharyngitis are sufficient supply of the body with vitamin D ₃ , restoration and maintenance of normobiocenosis on the pharyngeal mucosa. This predetermined the oral daily administration of vitamin D ₃ in a daily dose of 2000 ME (50 μg) in the treatment of chronic pharyngitis by the claimed method.

The probiotic complex Rioflora refers to a multi-species, multi-strain probiotics that have an effect on three levels, which have the ability to reproduce a complex intestinal ecosystem, restoring eubiosis, thus preventing the reproduction of pathogenic microflora in the intestinal lumen, helps to strengthen the natural barrier, activates immunity, increasing the level of immunoglobulins. RioFlora is a new generation probiotic. Contains 8 strains of microorganisms specially selected to reduce the risk of intestinal disorders (diarrhea, constipation, bloating (flatulence) caused by taking antibiotics).

Novocaine, getting on the mucous membrane of the nasopharynx, is partially absorbed, providing a weak local anesthetic effect, and relatively quickly hydrolyzed, decomposing into para-aminobenzoic acid and diethylaminoethanol, which has only a vasodilating effect. Para-aminobenzoic acid (vitamin B10) is a “growth factor” for representatives of symbiotic microflora. And the stimulation of the growth of symbiotic microflora is accompanied by the suppression of vegetation of non-resident microorganisms. In addition, para-aminobenzoic acid is an effective inducer of interferon, capable of having a normalizing effect on metabolism in connective tissue and optimizing the absorption of other B vitamins by the human body. Novocaine, as a precursor of para-aminobenzoic acid, in the human body also exhibits the properties of an interferon inducer. In addition, the pharmacological effects of novocaine are successfully complemented by manifestations of the physiological activity of emoxypine succinate, which are pathogenetically significant in chronic pharyngitis.

Emoxipina succinate has been known for a long time and is successfully used in the treatment of critical conditions. Emoxipine succinate has a wide range of pharmacological activity: it is antihypoxic, stress-protective, nootropic, anticonvulsant and anxiolytic agent, effectively inhibiting free radical lipid oxidation. This drug has an anti-inflammatory effect, improves microcirculation and stimulates reparative and regenerative processes. Such a wide range of pharmacological activity of emoxypine succinate is due to the drug's ability to stimulate succinate oxidase oxidation (compensatory pathway for ATP synthesis), phosphorylate in biological systems and have an inhibitory effect on serine and metal-dependent proteinases and chelate iron ions, thereby excluding the catalytic production of prooxidants with the participation of this metal ion valency. An important aspect of the pharmacological activity of emoxypine succinate is the ability of the biotransformation products of this substance to inhibit various proteinases. This, on the one hand, determines the anti-inflammatory and antiallergic effects of emoxipin succinate, and on the other hand, it can also determine the anti-influenza activity of this drug. It is known that for the penetration of the human influenza A virus into the cell, processing of the glycoproteins of the viral particle envelope is required, which is carried out by leukoproteinases (trypsin-like proteinases). Naturally, inhibition of secretory proteinases by phosphorylated derivatives of emoxipin may decrease the virulence of the human influenza A virus, i.e. suppression of the replication process of this DNA virus. The inflammatory response provides and maintains the presence of free iron ions in the area of inflammation, which, among other things, play the role of a "growth factor" for the pathogenic. A local decrease in the level of free iron ions in the soft tissues of the pharynx under the influence of phosphorylated derivatives of emoxypine succinate, capable of chelating iron ions, will manifest itself in the form of bacteriostatic effects. Antiviral and bacteriostatic manifestations of the pharmacological activity of the metabolites of emoxypine hydrochloride can be taken as an explanation of the effectiveness of emoxypine succinate as a means of treating chronic pharyngitis, treatment and prevention of pneumonia in acute exogenous poisoning. The spectrum of pharmacological effects of novocaine and emoxypine succinate to achieve the objective of the invention is complemented by manifestations of the physiological activity of Ambroxol hydrochloride. Thus, ambroxol hydrochloride stimulates the synthesis of enzymes that break down the bonds between molecules of mucopolysaccharides of sputum, reducing its viscosity and adhesive properties, enhances local immunity, activating tissue macrophages and increasing the level of secretory IgA, suppresses the production of inflammatory mediators, exhibits anti-edema and anti-inflammatory effects, suppresses inhibiting the formation of superoxide radical anion and stimulating the decomposition of nitric oxide.

The physiological activity of ambroxol hydrochloride enhances the spectrum of pharmacological effects of novocaine and emoxypine succinate.

The inventive method is a method for correcting the dysbiotic state of the nasal and oropharyngeal mucosa in the treatment of chronic pharyngitis, based on the combined non-invasive use of a complex cocktail including ambroxol hydrochloride, emoxypine succinate, novocaine (intranasal administration) with preliminary rinsing / rinsing of the nasal and oropharynx with 0.1% hydrogen peroxide solution, against the background of oral administration of vitamin D ₃ and Rioflora probiotic complex.)

The quantitative ratios of these drugs and the properties manifested in the treatment in aggregate have a major and direct impact on the technical result of the invention.

A combination of rinsing, rinsing the nasopharynx and oropharynx with a 0.1% hydrogen peroxide solution with a single oral administration of vitamin D ₃ at a dose of 1500-2500 ME, with the Rioflora probiotic complex, 1-3 capsules 2 times a day for up to 6 weeks, at least twice intranasal drip the introduction of a solution of drugs, which is made immediately before its introduction by mixing in one bottle equal volumes of 1.67% solution of emoxypine succinate and

0.25% ambroxol hydrochloride in 0.33% novocaine solution in each nasal passage for 7-8 minutes allows you to achieve the technical result.)

From the prior art, no technical solutions have been identified containing features that coincide with the distinctive features of the proposed method, therefore, the proposed method meets the criterion of inventive step.

The presence of essential features distinguishing from the prototype allows the claimed technical solution to be recognized as new.

The possibility of implementing the claimed invention in industry allows us to recognize it as corresponding to the criterion of industrial applicability.

All of the above pharmacological effects of drugs for the implementation of the claimed method of treatment - a combination of drugs - a complex cocktail consisting of 1.67% emoxypine succinate solution and 0.25% ambroxol hydrochloride in a 0.33% novocaine solution in a volume of 1.5 ml, 0 , 1% solution of hydrogen peroxide, vitamin D ₃ and the probiotic complex Rioflora allowed to confirm the effectiveness and duration of the clinical effect, sanitation of the mucous membrane from pathogenic microflora and virus carriers and restoration of eubiosis.

As can be seen from Table 1, in the group of patients with chronic pharyngitis, out of 86 patients with carriers of influenza and ARVI viruses, there were 45 people (52.3%), and after treatment with the claimed method, there were no cases of carriage in this group.

As can be seen from table 2, the indicators of carriage of pathogenic microorganisms on the nasopharyngeal mucosa in the group of patients with chronic pharyngitis who received complex treatment according to the claimed method, the content of Staphylococcus aureus decreased by 12.6 times, while in the group of patients according to the method - the prototype only 1.4 times; in the group according to the method we declared, the content of saprophytes decreased to 16.2 times, and according to the method - the prototype - up to 2.5 times. Carriage of Candida alblicans according to the claimed method - complete reorganization took place, according to the prototype method it decreased by 1.6 times, and therefore, the prototype method was less effective.

In addition to suppressing the vegetation of non-resident microorganisms on the nasopharyngeal mucosa in the treatment of chronic pharyngitis by the claimed method, stimulation of the growth of symbiotic bacteria was recorded (Table 3). As can be seen from table 3, the indicators of colonization of the mucous membrane of the nasopharynx by autochthonous microorganisms after treatment with the claimed method reached the normal values, while during the treatment according to the prototype method this indicator was not achieved.

The dynamics of exacerbations of chronic pharyngitis in the treatment of the claimed method is presented in table 4. During the observation for 1.5 years, during the treatment by the claimed method, 91.9% did not seek medical help. In the treatment according to the prototype method, only 46.9% of patients have sought medical help within a year.

When comparing the clinical efficacy of treatment of patients with chronic pharyngitis according to the claimed method (main group 86 patients) and according to the prototype method (control group 32), it was revealed:

• Relief of edema and hyperemia of the pharyngeal mucosa according to the claimed method was fixed at 3.1 ± 0.5 days, and in patients treated according to the prototype method only at 8.1 ± 1.3 days (P <0.001);

• The disappearance of the discharge and plaque on the posterior pharyngeal wall was observed according to the claimed method, was observed on day 2.7 ± 0.45, and in patients treated according to the prototype method, on day 5.4 ± 0.8 (P <0.02);

• The complete absence of inflammation in the pharynx by the end of the course of treatment according to the claimed method was registered in 94.2% (81 patients) and in 37.5% (12 people) of patients treated according to the prototype method (P <0.001);

• Restoration of normal eubiosis of the mucous membrane of the nasopharynx and oropharynx at the end of treatment with the claimed method in microbiological examination was in 94.2% of cases, with treatment according to the prototype method only in 9.3% of cases (P <0.001).

Carriage of pathogens of a viral nature in the nasopharynx before and after treatment by the claimed method and by the prototype method

Table 1

Method of treatment Carriage of ARVI viruses in the group (people /%) Sanitation (times) before treatment after treatment Prototype method (n = 32) 16/50 12 / 37.5 1.33 The claimed method (n = 86) 45 / 52.3 0/0 -

Bacteriological landscape in the nasopharynx before and after treatment by the claimed method and by the method - prototype

table 2

Group Group I (n = 32) Group III (n = 86) Nasopharyngeal carriage in the group (%) Time Nasopharyngeal carriage in the group (%) Time Type of pathogen Before treatment After treatment Before treatment After treatment S. aureus 50 34.3 1.4 29.1 2,3 12.6 Saprophytes 15.7 6.2 2.5 37.2 2,3 16.2 Candida alblicans 34.3 21.9 1.6 33,7 - Full Polyflora - - - eight - Full

Colonization of the nasopharynx with indigenous microorganisms before and after treatment with the claimed method and according to the prototype method

Table 3

Method of treatment Type of bacteria Microbiocenosis of the nasopharynx (CFU / ml) before treatment after treatment Method - prototype (n = 32) Lactobacterium spp. (0-0.8) 10 ² (0.2-0.7) 10 ³ Bifidobacterium spp. (0-0.8) 10 ² (0.2-0.6) 10 ³ The claimed method (n = 86) Lactobacterium spp. (0-0.8) 10 ² (0.8-9.9) 10 ³ Bifidobacterium spp. (0-0.8) 10 ² (0.7-0.9) 10 ³

Dynamics of requests for 18 months

Table 4

Aggravation, pers. (%) Remission, people (%) The claimed method (n = 86) 7 (8.1) 79 (91.9) Method - prototype (n = 32) 15 (46.9) 17 (53.1)

The inventive method is carried out as follows.

Every day, before using drugs, rinse and rinse the nasopharynx and oropharynx with a 0.1% solution of hydrogen peroxide, then vitamin D ₃ is administered orally at a dose of 1500-2500 ME, the probiotic complex Rioflora 1-3 capsules 2 times a day up to 6 weeks and at least twice intranasally, a solution of drugs is injected, which is made immediately before its administration by mixing in one bottle equal volumes of 1.67% solution of emoxypine succinate and 0.25% ambroxol hydrochloride in 0.33% solution of novocaine into each nasal move for 7-8 minutes.

Example 1

Every day, before using drugs, rinse and rinse the nasopharynx and oropharynx with a 0.1% solution of hydrogen peroxide, then a single oral dose of vitamin D ₃ is injected at a dose of 1500 ME, the probiotic complex Rioflora, 1 capsule 2 times a day for up to 6 weeks and at least at least twice intranasally, a solution of drugs is injected, which is made immediately before its administration by mixing in one bottle equal volumes of 1.67% solution of emoxypine succinate and 0.25% ambroxol hydrochloride in 0.33% solution of novocaine into each nasal passage for 7 -8 minutes.

Patient A. 69 years old. Diagnosis: Chronic pharyngitis, hypertrophic form. Complaints: Over the past 3 years, the patient has been complaining of a tickling sensation, a burning sensation in the throat especially in the morning, an occasional cough with a scant amount of mucus, a feeling of heaviness and fullness in the epigastric region after eating, a feeling of a lump in the throat.

Medical history: Ill for about 3 years, episodically disturbed by the above complaints. She notes a deterioration in her condition since September 2017, when all of the above complaints became more pronounced, the temperature periodically increased to subfebrile numbers (37 - 37.2 C). In addition, a pronounced weakness appeared, especially at the end of the working day. For 4 weeks, therapy was carried out according to the claimed method: against the background of a daily single oral administration of a solution of vitamin D3 at a dose of 1500 ME (50 μg) and the probiotic complex Rioflora, 1 capsule 2 times a day with preliminary rinsing / rinsing of the nose / oropharynx 0.1% a solution of hydrogen peroxide is prescribed twice daily, intranasally, a 1.67% solution of mexidol (emoxypine succinate) and 0.25% lazolvan (ambroxol hydrochloride) in a 0.33% solution of novocaine in a volume of 1.5 ml in each nasal passage for 7-8 minutes (1 ml of solution contains 16.7 mg emoxypine succinate, 2.5 mg ambroxol hydrochloride and 3.3 mg novocaine). Additional follow-up examination by a gastroenterologist.

Objectively: Nose, ears without inflammation. The oropharynx: the mucous membrane is hyperemic, the lateral ridges are thickened, hyperemic, the tonsils are deep between the palatine arches, when the anterior arch is pressed, the contents in the lacunae were not detected.

Conclusion of FGDS: catarrhal duodenitis, chronic gastritis, cardia insufficiency 1, catarrhal esophagitis.

After the therapy, the improvement occurred on the 20th day after the start of treatment, but the symptoms of the disease did not completely disappear. The relief of edema and hyperemia of the pharyngeal mucosa was recorded on the 10th day. Relapse was observed 8 months after the end of treatment.

Example 2

The inventive method is carried out according to example 1.

At a dose of vitamin D ₃ at a dose of 2500 ME, the probiotic complex of Rioflora, 3 capsules 2 times a day for up to 6 weeks and at least twice intranasally, a solution of drugs is injected, which is prepared immediately before its administration by mixing in one bottle of equal volumes 1, 67% solution of emoxypine succinate and 0.25% ambroxol hydrochloride in 0.33% solution of novocaine in each nasal passage for 7-8 minutes.

Patient A. 40 years old. Diagnosis: Chronic pharyngitis atrophic form.

Complaints: Over the past 7 years, the patient has been complaining of a feeling of perspiration, a burning sensation in the throat especially in the morning, an occasional cough with a scant amount of mucus, a feeling of heaviness and fullness in the epigastric region after eating, a feeling of a lump in the throat, heartburn.

Medical history: Ill for about 3 years, episodically disturbed by the above complaints. She notes a deterioration in her condition since March 2017, when all of the above complaints became more pronounced, the temperature periodically increased to subfebrile numbers (37 - 37.2 C). In addition, a pronounced weakness appeared, especially at the end of the working day. For 4 weeks, therapy was carried out according to the claimed method: against the background of a daily single oral administration of a solution of vitamin D3 at a dose of 2500 ME (50 μg) and the probiotic complex Rioflora, 3 capsules 2 times a day with preliminary rinsing / rinsing of the nasal / oropharynx 0.1% a solution of hydrogen peroxide is prescribed twice daily, intranasally, a 1.67% solution of mexidol (emoxypine succinate) and 0.25% lazolvan (ambroxol hydrochloride) in a 0.33% solution of novocaine in a volume of 1.5 ml in each nasal passage for 7-8 minutes (1 ml of solution contains 16.7 mg emoxypine succinate, 2.5 mg ambroxol hydrochloride and 3.3 mg novocaine). Additional follow-up examination by a gastroenterologist.

Objectively: Nose, ears without inflammation. The oropharynx: the mucous membrane is hyperemic, the lateral ridges are thickened, hyperemic, single follicles are observed on the posterior wall, tonsils deep between the palatine arches, when pressing on the anterior arch, the contents in the lacunae were not determined.

Conclusion of FGDS: Catarrhal duodenitis. Duodeno-gastric reflux. Chronic gastritis. Esophagitis is catarrhal.

After the therapy, the improvement occurred on the 14th day after the start of treatment, but the symptoms of the disease did not completely disappear. The relief of edema and hyperemia of the pharyngeal mucosa was recorded on the 7th day. There were no relapses, but there were side symptoms of nausea, vomiting and headaches were observed once.

Example 3

The inventive method is carried out according to example 1.

At a dose of vitamin D ₃ at a dose of 3000 IU, the probiotic complex of Rioflora at a dose of 4 capsules 2 times a day for up to 6 weeks and at least twice intranasally, a solution of drugs is injected, which is prepared immediately before its administration by mixing in one bottle of equal volumes of 1.67% solution of emoxypine succinate and 0.25% ambroxol hydrochloride in 0.33% solution of novocaine in each nasal passage for 7-8 minutes.

Patient L. 55 years old. Diagnosis: Chronic pharyngitis mixed form

Complaints: For the past 7 years, the patient complains of a feeling of perspiration, burning, sore throat, especially in the morning, an occasional cough with a scant amount of mucus, a feeling of heaviness and fullness in the epigastric region after eating, a feeling of lump in the throat, heartburn.

Medical history: Sick for about 7 years, episodically disturbed by the above complaints. She notes a deterioration in her condition since November 2017, when all of the above complaints became more pronounced, the temperature periodically increased to subfebrile numbers (37 - 37.2 C). In addition, a pronounced weakness appeared, especially at the end of the working day. For 4 weeks, therapy was carried out according to the claimed method: against the background of a single daily oral administration of a solution of vitamin D3 at a dose of 3000 ME (50 μg) and the probiotic complex Rioflora, 4 capsules 2 times a day with preliminary rinsing / rinsing of the nasal / oropharynx with 0.1% a solution of hydrogen peroxide is prescribed twice daily, intranasally, a 1.67% solution of mexidol (emoxypine succinate) and 0.25% lazolvan (ambroxol hydrochloride) in a 0.33% solution of novocaine in a volume of 1.5 ml in each nasal passage for 7-8 minutes (1 ml of solution contains 16.7 mg emoxypine succinate, 2.5 mg ambroxol hydrochloride and 3.3 mg novocaine). additional examination by a gastroenterologist.

Objectively: Nose, ears without inflammation. Oropharynx: mucous "varnished", lateral ridges thickened, hyperemic, single follicles are observed on the posterior wall, tonsils in the depth between the palatine arches, when pressing on the anterior arch, the contents in the lacunae were not determined.

Conclusion of FGDS: Catarrhal duodenitis. Duodenitis is reactive. Chronic gastritis. Esophagitis is catarrhal.

After the therapy, the improvement occurred on the 14th day after the start of treatment, but the symptoms of the disease did not completely disappear. The relief of edema and hyperemia of the pharyngeal mucosa was recorded on the 7th day. There were side symptoms of nausea, vomiting, headaches, intestinal colic, metallic taste in the mouth.

Example 4

The inventive method is carried out according to example 1.

At a dose of vitamin D ₃ at a dose of less than 1500 ME, the probiotic complex Rioflora at a dose of less than 1 capsules 2 times a day for up to 6 weeks, and at least twice intranasally, a solution of drugs is injected, which is prepared immediately before its administration by mixing in one bottle of equal volumes of 1.67% solution of emoxypine succinate and 0.25% ambroxol hydrochloride in 0.33% solution of novocaine in each nasal passage for 7-8 minutes.

Patient N., 41 years old. Diagnosis: Chronic pharyngitis, hypertrophic form

Complaints: During the last 3 years, the patient complains of pain, a feeling of perspiration, a burning sensation in the throat, especially in the morning, a dry cough with difficult sputum, a feeling of a lump in the throat, heartburn.

Medical history: Sick for about 3 years, occasionally disturbed by the above complaints. She notes a deterioration in her condition since February 2018, when all of the above complaints became more pronounced, the temperature periodically increased to subfebrile numbers (37 - 37.2 C). In addition, a pronounced weakness appeared, especially at the end of the working day. For 4 weeks, therapy was carried out according to the claimed method: against the background of a single daily oral administration of a solution of vitamin D3 at a dose of 1000 ME (50 mcg) and the probiotic complex Rioflora, 1 capsule 1 time per day with preliminary rinsing / rinsing of the nasal / oropharynx 0.1% a solution of hydrogen peroxide is prescribed twice daily, intranasally, 1.67% solution of mexidol (emoxypine succinate) and 0.25% lazolvan (ambroxol hydrochloride) in a 0.33% solution of novocaine in a volume of 1.5 ml in each nasal passage for 7-8 minutes (1 ml of solution contains 16.7 mg emoxypine succinate, 2.5 mg ambroxol hydrochloride and 3.3 mg novocaine). Additional follow-up examination by a gastroenterologist.

Objectively: Nose, ears without inflammation. The oropharynx: the mucous membrane is hyperemic, the lateral ridges are thickened, hyperemic, the tonsils are deep between the palatine arches, when the anterior arch is pressed, the contents in the lacunae were not detected.

Conclusion of FGDS: Duodenitis reactive. Catarrhal bulbit. Chronic gastritis. Insufficiency of the cardia 1. Catarrhal esophagitis.

After the therapy, the improvement occurred on the 14th day after the start of treatment, but the symptoms of the disease did not completely disappear. The relief of edema and hyperemia of the pharyngeal mucosa was recorded on the 7th day. There were no relapses, but there were side symptoms of nausea, vomiting, headaches, and intestinal colic were observed once.

Example 5

The inventive method is carried out according to example 1.

At a dose of vitamin D ₃ at a dose of 2000 ME, the probiotic complex Rioflora at a dose of 2 capsules 2 times a day for up to 6 weeks and at least twice intranasally, a solution of drugs is injected, which is prepared immediately before its administration by mixing in one bottle of equal volumes 1 , 67% solution of emoxypine succinate and 0.25% ambroxol hydrochloride in 0.33% solution of novocaine in each nasal passage for 7-8 minutes.

According to example 5, the best results are achieved in the method of treatment.

Patient O., 45 years old. Diagnosis: chronic pharyngitis, hypertrophic form

She applied in November 2017 with complaints of perspiration, burning, dry throat, mainly in the morning, recurrent cough with difficult to separate (productive) sputum. Considers himself sick for about 12 years. The last 2 months the condition worsened: there was a general malaise, weakness, the presence of a foreign body in the throat - a "lump" in the throat. On examination: Nose, ears - normal. Oropharynx: mucous edematous, hyperemic. On the posterior wall of the pharynx there are pronounced follicles, the lateral ridges are thickened.

A consultation with a gastroenterologist was prescribed, with EGDS revealed catarrhal bulbitis, catarrhal duodenitis, erosive gastritis, acute gastric ulcer, cardia insufficiency 1, catarrhal esophagitis. Prescribed local antioxidant therapy with preliminary treatment of the mucous membrane of the pharynx with a specially prepared 0.1% hydrogen peroxide solution, in the form of a cocktail solution of ambroxol hydrochloride 1 ml, emoxypine succinate 1 ml, novocaine 1 ml, intranasally drip for 7-8 minutes. Vitamin D ₃ - 2000 IU orally on an empty stomach. The therapy was prescribed for 6 weeks.

At the end of the treatment, the condition is satisfactory, no complaints. When followed up to 12 months, there were no relapses.

In the examples given.

The minimum dose of vitamin D ₃ is 1500 IU, because a smaller dose is ineffective.

The maximum dose of vitamin D ₃ is 2500 IU, because a large dose is associated with the risk of complications (nausea, vomiting, deterioration of health).

The optimal dose of vitamin D ₃ for the statistical majority of patients is 2000 IU.

The minimum dose of Rioflora is 1 capsule 2 times a day. a smaller dose is ineffective.

The maximum dose of Rioflora is 3 capsules 2 times a day. a large dose is associated with the risk of complications (nausea, vomiting, deterioration of health).

The optimal dose of Rioflora for the statistical majority of patients is 2 capsules 2 times a day.

The use of the proposed method will ensure the achievement of the stability of the clinical effect, the complete restoration of the microbiota of the mucous membrane of the upper respiratory tract, the prevention of the chronic course of the disease.

Claims (1)

A method of treating chronic pharyngitis, in which the nasopharynx and oropharynx are washed and rinsed with hydrogen peroxide, novocaine, lazolvan - ambroxol hydrochloride and mexidol - emoxypine succinate, vitamin D ₃ and the probiotic Rioflora complex, rinsing and rinsing the nasal and the oropharynx with hydrogen peroxide is carried out daily with a 0.1% solution, before using drugs, a solution of drugs is prepared immediately before its introduction by mixing in one bottle equal volumes of 0.5 ml of 1.67% solution of emoxypine succinate, 0.5 ml 0, 33% ampoule solution of novocaine and 0.5 ml of 0.25% ampoule solution of lazolvan - ambroxol hydrochloride, the introduction of a solution of drugs is carried out at least twice intranasally drip into each nasal passage for 7-8 minutes, vitamin D _{3 is} prescribed orally daily in a daily dose at a dose of 1500-2500 ME for three to four del and oral probiotic complex Rioflora 1-3 capsules 2 times a day for up to 6 weeks.